HIV/AIDS Prevention in the Agricultural Sector in Malawi

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Landwirtschaftlich-Gärtnerische Fakultät

Schriftenreihe des Seminars für Ländliche Entwicklung

HIV/AIDS Prevention in the Agricultural Sector in Malawi.

A Study on Awareness Activities and Theatre.

Dr. Harald Braun (Team Leader) Natascha Vogt

Till Baumann Doris Weidemann Peter Dupree

SLE:

Podbielskialle 66

14195 Berlin, Germany

Phone: +49 – 30 – 31471334 Fax: +49 – 30 – 31471409 http://www.agrar.hu-berlin.de/sle Berlin, November 2001

SLE

CENTRE FOR ADVANCED TRAINING IN RURAL DEVELOPMENT

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(Malawi, S192)

Schriftenreihe des SLE (Seminar für Ländliche Entwicklung)

(Publication Series by the Centre for Advanced Training in Rural Development) Herausgeber: SLE (Seminar für Ländliche Entwicklung)

(Editors) (Centre for Advanced Training in Rural Development)

Humboldt-Universität zu Berlin (Humboldt University Berlin)

Podbielskiallee 66

D-14195 Berlin, Federal Republic of Germany Phone: 0049-30-314 71334;

Fax: 0049-30-314 71409

E-mail: sabine.doerr@agrar.hu-berlin.de URL: http://www.agrar.hu-berlin.de/sle URL: http://www.berlinerseminar.de Redaktion: Dr. Karin Fiege

(Managing Editor) SLE (Seminar für Ländliche Entwicklung) Druck: Offset-Druckerei Gerhard Weinert GmbH

(Printers) Saalburgstr. 3

D-12099 Berlin

Verlag und Vertrieb: Margraf Verlag (Publishers and Postfach 105

Distributors) D-97985 Weikersheim 1. Auflage 2001: 1-400

(1st edition 2001)

ISSN 1433-4585

ISBN 3-8236-1359-6

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Foreword

This report is the result of a three months project carried out by a consultant team of the Centre for Advanced Training in Rural Development (SLE), Humboldt University Berlin, at the request of the Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ). The team members, with the exception of the team leader and the US-American team member, participated in the 39^th annual training course.

Interdisciplinary consultancy projects are an integral part of SLE’s training programme. The programme aims at preparing young professionals for assignments in bilateral and multilateral development organisations. It enables participants to obtain valuable practice in the use of action- and decision- oriented appraisal methods. At the same time, projects contribute to identifying and solving problems in rural development.

In 2001, the five groups of SLE’s 39th course simultaneously conduct projects in Sierra Leone, Ecuador, Sri Lanka, on the Philippines and in Malawi.

Prof. Dr. Ernst Lindemann Dean

Faculty of Agricultural and Horticultural Sciences

Dr. Bernd Schubert Director

SLE – Centre for Advanced Training in Rural Development

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Acknowledgements

This research document could not have been completed without the help, support, and advice along with valuable insights and information provided by myriad persons, communities, and organisations throughout Malawi.

The SLE Study Team is indebted to the administration and staff of the Government of Malawi’s Ministry of Agriculture and Irrigation and specifically the MoAI’s Department of Agriculture Extension Services, under whose patronage this paper was undertaken, for their tireless efforts to smooth the way for our research. Among these, Mr. D. Kamputa (Director of the DAES), Dr. G. Malindi (Deputy Director of the DAES), Ms. S. Kankwamba, Ms. N.

Mipando, Ms. G.B. Moyo, Ms. L.N.M. Mwenda, Ms. A. Mgomezulu and the Development Officers of the three respective Extension Planning Areas encompassed in our study, Mr. H.J.P. Chafuwa, Ms. A.B. Chikwati, and Mr.

A.T.Y. Mtengezu were of particular support and their advice was immeasurable.

Many thanks to Dr. W. Ehret and GTZ, without whose backing and encouragement this study could not have been undertaken, much less completed.

A special thanks to Mr. W.A.K. Banda, Ms. J. Chafuwa, Ms. A.B. Chikwati, Ms.

V.N. Dausi, Mr. M. Gundo, Ms. S.M. Jere, Mr. A. Kaipa, Mr. A. Lazarus, Mr. F.

Mkanya, Mr. E. Moyo, Mr. Tozi, Peter Kakatera, and Christine Chidaya for their peerless translations during interviews, theatre performances, and village events throughout our field phase. And to Mr. S. Bota of Bunda College for providing invaluable insight and background into rural development and Malawian cultural practices.

We benefited enormously from the time spent with Chileka Health Centre Drama Group, Chitedze HIV/AIDS Awareness Group, Chitipi Drama Group, Chosamua Chinamva Nkhwangwa Iri M'Mutu, Kupewa Drama Group, Luntha Drama Group, Mandala Drama Group, Manyanda Drama Group, Matunduluzi School Edzi Toto Club, NAPHAM Drama Group, Njewa Drama Group, and St.

Anne's Drama Group. In particular the expertise of the ACB’s Mr. B. Chimbalu and Mr. E. Mkhosi along with The Story Workshop’s Mr. M. Mbwana, Ms. L.

Keyworth and Ms. P. Brooke was very useful.

We are very grateful for the hospitality of Dr. F. Abodunrin and Mr. M.

Magalasi at Chancellor College as well as for the excellent support by Dr. D.

Kerr and Dr. E. Breitinger. Thank you also to Mrs. E. Jiyani (Department of

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Youth), Mr. K. Black (NAPHAM) and Mr. T. Chiphwanya (PSI), who spontaneously provided us with interesting materials.

Our work could not have been accomplished without the interest and openness of the many dedicated extension workers from the Ministries of Agriculture and Irrigation, Health and Population, and Education who work tirelessly in the pilot area. Nor could anything have been possible without the cooperation and hospitality of those villages and communities in the Chileka, Ming’ongo, and Mpingu Extension Planning Areas in which we visited and worked.

And a general thank you to any and all who have provided support and services that aided us in our work. We are sorry that not everyone could have been mentioned by name.

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Index of Ta-

bles………

………

TAB.2.1:INDICATORS FOR MALAWI... 11 TAB.2.2:ESTIMATED NUMBER OF ADULTS AND CHILDREN LIVING WITH HIV/AIDS, END OF 199912 TAB.2.3:ESTIMATED NUMBER OF DEATHS DUE TO AIDS DURING 1999 ... 12 TAB.2.4ESTIMATED NUMBER OF ORPHANS... 12 TAB.2.5:HIV PREVALENCE ESTIMATES (NACP,2001:13)... 13 TAB.2.6:KEY HIV/AIDS INDICATORS FROM THE SPECTRUM PROJECTION,1982-2012(NACP,

2001:17) ... 17 TAB.2.7:FACTS ABOUT CHILEKA EPA,MING'ONGO EPA, AND MPINGU EPA(SOURCE:ADD-

REPORT;RDPLILONGWE WEST,CROP ESTIMATES 2001) ... 24 TAB.5.1:THE TOT PARTICIPANTS BREAKDOWN INTO POSTING / PROFESSION, NUMBER OF

PARTICIPANTS, SEX, AND WORKPLACE... 40 TAB.5.2:STATISTICAL DATA ON THE VILLAGE EVENTS... 46 TAB.5.3:LIST OF TOPICS COVERED DURING EIGHT VILLAGE EVENTS... 48 TAB.5.4:POSITIVE ANSWERS OF DIFFERENT AGE GROUPS TO THE QUESTION ABOUT THEIR OPINION

ON CONDOMS... 55 TAB.5.5:NEGATIVE ANSWERS OF THE VILLAGERS TO THE QUESTION “WHAT IS YOUR OPINION ON

FISI?” ... 57 TAB.5.6:POSITIVE ANSWERS CONCERNING THE QUESTION (1)“DO YOU DISCUSS HIV/AIDS

RELATED MATTERS WITHIN YOUR FAMILY?” AND (2)“DO YOU DISCUSS HIV/AIDS RELATED MATTERS WITHIN YOUR COMMUNITY?”... 57

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Index of Figures

FIG.2.1:MALAWI AND NEIGHBOURING COUNTRIES (ENCARTAWORLDATLAS,2001)... 10

FIG.2.2:MAJOR MODES OF HIV TRANSMISSION IN SUB-SAHARAN AFRICA... 16

FIG.3.1:ORGANISATIONAL STRUCTURE OF THE MINISTRY OF AGRICULTURE AND IRRIGATION (MOAI) ... 27

FIG.3.2:ORGANISATIONAL STRUCTURE OF THE LILONGWE AGRICULTURE DEVELOPMENT DIVISION /RURAL AIDSPILOT AREA... 27

FIG.4.1:INTERVIEW WITH ONE OF THE FEMALE VILLAGERS AFTER THE VILLAGE EVENT IN THUMBI ON 5SEPTEMBER 2001 ... 35

FIG.4.2:GROUP INTERVIEW WITH CHITEDZE HIV/AIDSAWARENESS GROUP... 37

FIG.5.1:ONE OF THE TOT PARTICIPANTS DEMONSTRATING THE CORRECT USE OF A CONDOM AT THE MASAKAMIKA VILLAGE EVENT ON 15AUGUST 2001 ... 50

FIG.6.1:HUSBAND AND WIFE ARGUING (CHITEDZE HIV/AIDSAWARENESS GROUP) ... 81

FIG.6.2:GETTING ADVICE ON HIV/AIDS(CHILEKA HEALTH CENTRE DRAMA GROUP) ... 83

FIG.6.3:LAMENTING THE DEATH OF A CLOSE RELATIVE (CHOSAMUA CHINAMVA NKHWANGWA IRI M'MUTU) ... 84

FIG.6.4:DISCUSSING THE HUSBAND’S BEHAVIOUR (MANYANDA DRAMA GROUP) ... 87

FIG.6.5:CHILDREN PERFORMING DANCES AND SONGS ON HIV/AIDS... 97

FIG.6.6:A SING’ANGA (TRADITIONAL HEALER) AND SOME OF HIS TOOLS... 97

FIG.6.7:A MAN FALLING SICK FROM AIDS(KUPEWA DRAMA GROUP) ... 98

FIG.6.8:RECITING A POEM... 98

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List of Abbreviations

ACB Agriculture Communication Branch ADD Agricultural Development Division AES/GTZ Agriculture Extension Support

ANC Ante-Natal Care

BCI Behavioural Change Intervention CCTT Chancellor College Travelling Theatre

DAES Department of Agriculture Extension Services

DO Development Officer

EPA Extension Planning Area

FAO Food and Agriculture Organisation of the United Nations GTZ Gesellschaft für Technische Zusammenarbeit GmbH

(German Agency for Technical Cooperation)

ha Hectare

HBC Home Based Care

HIV/AIDS Human Immuno-deficiency Virus / Aquired Immuno- deficiency Syndrome

HAS Health Surveillance Assistant

ICRAF International Centre for Research in Agroforestry MBC Malawi Broadcasting Corporation

MK Malawi Kwacha (1US$ ca. 70 MK) MoAI Ministry of Agriculture and Irrigation

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MoHP Ministry of Health and Population NAC National Aids Commission

NACP National Aids Control Programme

NAPHAM National Association for People Living with HIV/AIDS in Malawi

NGO Non-Governmental Organisation PHCU Primary Health Care Unit

PSI Population Services International RDP Regional Development Project

SLE Seminar für ländliche Entwicklung (Centre for advanced training on rural development)

STD Sexually Transmitted Disease STI Sexually Transmitted Infection

SWET The Story Workshop Educational Trust ToT Training of Trainers

UNAIDS Joint United Nations Programme on HIV/AIDS VCT Voluntary HIV Counselling and Testing

VHC Village Health Committee

WHO World Health Organisation of the United Nations

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EXECUTIVE SUMMARY 3

Executive Summary

Malawi is among the least developed countries in the world and is also one of the worst hit by the pandemic. About 16% of the population aged 15-49 years live with HIV/AIDS. The impact of the disease can be felt on every facet of the society, but since 85% of the population earn their living from agriculture, this sector is especially hard hit by the epidemic.

The Department of Agriculture Extension Services (DAES) within the Ministry of Agriculture and Irrigation (MoAI) recognised the challenge to fight the further spread of the disease. It also recognised the impact HIV/AIDS has on its extension staff and the target group, the rural farmers. The organisation of a Training of Trainers Workshop for extension workers, other field level staff, and community representatives as well as the exploration of alternative ways of communicating HIV/AIDS matters in the communities and the workplace were the first steps in response to the spread of HIV/AIDS.

In May 2001 the DAES conducted the first Training of Trainers Workshop to enable the participants to organise and conduct village events on HIV/AIDS issues as multi-sectoral facilitator teams. This programme has been implemented in three Extension Planning Areas (EPAs) in the pilot area Lilongwe West Rural Development Project (RDP).

A research team from the Centre for Advanced Training in Rural Development (SLE) undertook a three month study project supported by the Agriculture Exten- sion Support project of GTZ (Deutsche Gesellschaft für Technische Zusam- menarbeit). The two main objectives of the study project were to explore possibilities of integrating theatre into the DAES activities related to HIV/AIDS and to evaluate the training of community representatives and extension staff and to give recommendations based on the findings. The overall purpose of the project is for the DAES to use the results and recommendations of the study to further improve its services in the field of HIV/AIDS prevention and mitigation in the rural agriculture sector.

The research team observed village events, compared the knowledge on HIV/AIDS matters between field staff who have and have not been part of the training of trainers workshop, and assessed the knowledge on HIV/AIDS at village level.

The team found numerous reasons for encouragement in the work of the trained field staff. At the same time the team noted areas for improvement and clarifica-

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tion to be addressed and implemented in the next Training of Trainers Work- shops. Proposed interventions could include:

• Updating and revising the Training of Trainers Workshop curriculum.

• Undertaking a follow-up training for Training of Trainers Workshop participants incorporating new subject matter along with expanded training of key topics previously covered.

• Highlighting gender-based issues.

• Development of a manual to help facilitators to improve organisation and conduction of HIV/AIDS awareness meetings.

• Emphasising and encouraging cross-sectoral facilitation teams.

• Increased cooperation with NGOs working in HIV/AIDS related issues.

• More defined cooperation between ministries.

Regarding the subject of theatre and HIV/AIDS, the research team observed theatre performances, conducted group interviews with drama groups as well as post-performance interviews with spectators and with various theatre specialists and practitioners.

The high motivation of the drama groups and the impressing theatre performances observed, suggest that there is great potential in the exploration of theatre as an alternative form of communicating HIV/AIDS issues. Thus, possible ways of integrating theatre into the activities of the DAES are outlined in the study.

Several key interventions involving theatre include:

• Redesigning the Training of Trainers Workshop curriculum to contain at least three days of training on theatre skills.

• Integrating modules on theatre skills into the follow-up training for participants of the Training of Trainers Workshop of May 2001.

• Organising an integrated HIV/AIDS and theatre training for representatives of community drama groups.

• Integrating the expertise of experienced theatre practitioners into theatre skills trainings.

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EXECUTIVE SUMMARY 5

• Supporting drama groups willing to perform at places outside their imme- diate environments.

• Supporting the formation of workplace drama groups in the MoAI.

• Establishing regular dialogues between different drama groups.

The study concludes that the Training of Trainers approach of the Ministry of Ag- riculture should be scaled up to a country-wide programme and that theatre should be integrated into the activities.

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INTRODUCTION 7

1 Introduction

The HIV/AIDS pandemic has become a serious health and development problem in many countries around the world. The Joint United Nations Programme on AIDS (UNAIDS) estimates the number of HIV infections worldwide at about 34.3 million by the end of 1999 (UNAIDS, 1999). About 24.5 million infected people – 70 percent of the total – are living in sub-Saharan Africa. No cure is available for AIDS, and the disease threatens the social and economic well-being of the countries.

The economic effects of HIV/AIDS are felt first by individuals and their families.

The household impacts begin as soon as a member of the household starts to suffer from HIV related illnesses. Illness increases the amount of money the household spends on health care, keeps workers away from their duties and causes school drop-outs, especially of girls who often have to care for the patient and to assist their families by earning money. When children are withdrawn from school in order to save educational expenses and increase the labour supply, the household suffers a severe loss of future earning potential.

In Malawi, as in most other African economies, agriculture is the largest sector, and also one of the worst hit by the pandemic. Studies have shown that HIV/AIDS will have devastating effects on agricultural productivity caused by loss of labour supply which is likely to lead farmers to cultivate less labour-intensive crops. In many cases this may mean switching from cash crops to subsistent food crops. Production will also suffer from loss of knowledge since more and more households are headed by children.

The Ministry of Agriculture and Irrigation (MoAI) and its Department of Agriculture Extension Services (DAES) recognised the impact HIV/AIDS has had on farming communities as well as among its extension staff:

“The challenge to agricultural extension is, firstly, to maintain a healthy, energetic human resource both in the extension services and in the farming community, and, secondly, to prevent further spread of HIV/AIDS. This requires integration of HIV/AIDS mitigation measures in the agricultural development programmes on the assumption that a healthy nation is a productive nation. The programme on factoring HIV/AIDS awareness in agriculture should therefore be strengthened.

Staff in the Ministry of Agriculture and Irrigation will also need HIV/AIDS education.” (MOAI, 1997:7)

Responding to the mission statement of “promoting equalisation (i.e. both equal-

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ity and equity) in agricultural extension service provision through advocacy of gender, empowerment, poverty, environment, and HIV/AIDS concerns” (MOAI, 1997:12), the DAES with the assistance of the Agriculture Extension Support project (AES/GTZ) and Family Health International (FHI) conducted a Training of Trainers (ToT) Workshop on HIV/AIDS issues for extension staff and community representatives of the pilot area in the Lilongwe West Rural Development Project (RDP) in May 2001.

This ToT Workshop was intended to enable the participants to organise and conduct village events on HIV/AIDS awareness, spread, and control. These village events are supposed to be included in the daily work of the extension workers in co-operation with the training participants of other institutions and community representatives in order to form multi-sectoral teams (see 3.2.1).

A current interest of the MoAI is the exploration of alternative ways to disseminate HIV/AIDS information and to communicate HIV/AIDS issues in the communities and at the workplace. In particular theatre is regarded to be a useful IEC (Information, Ecucation, Communication) approach to respond to the epidemic which can become part of a Behavioural Change Initiative (BCI).

1.1 Objectives of the project

The SLE (Seminar für Laendliche Entwicklung – Centre for Advanced Training in Rural Development) study project on the subject “HIV/AIDS Prevention in the Ag- ricultural Sector in Malawi. A Study on Awareness Activities and Theatre.” has been conducted on behalf of the AES/GTZ project during a three-month research phase in Malawi.

During the discussion on the results of the study the DAES expressed most interest in the exploration of theatre as a possible medium for HIV/AIDS awareness activities, besides the evaluation of the ToT Workshop and an assessment of the follow-up activities. The purpose of the study was to find out whether the Training of Trainers Workshop was successful and fulfilled its task to enable the participants to conduct village events and also to explore possibilities to integrate theatre into the prevention activities to make the efforts of the Department of Agricul- ture Extension Services (DAES) even more effective and efficient. According to this discussion the results were defined as follows:

• Possibilities of integrating theatre into the DAES activities related to

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INTRODUCTION 9 HIV/AIDS are explored.

• The training of community representatives and extension staff is evalu- ated and recommendations are given. These include possibilities of communicating the impact of HIV/AIDS on farming systems on village level.

These results should serve the goal of the project:

The rural population is empowered to prevent the spread of HIV/AIDS and to mitigate the impact of the epidemic.

As can be derived from the results, the focus of the study is to explore possibilities of integrating theatre into the HIV/AIDS prevention activities and to assist the Training of Trainers (ToT) Workshop participants by assessing their potential and needs, as well as giving recommendations concerning both subjects.

1.2 Procedure of the project

The findings of the study ensue from a six-week preparatory phase in Berlin, Germany, and three-months research in Malawi. During the preparation phase, objectives were discussed, research questions were formulated, a working plan was drawn up, and a tool box of different methods was created.

The research in Malawi itself was divided into four phases:

• Week 1: Visits to relevant organisations and institutions, literature research, final agreement on results

• Week 2 to 6: Field phase, followed by the presentation of preliminary results

• Week 7 to 9: Report writing, submission of draft report to stakeholders

• Week 11 to 12: Presentation of final result

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2 Background information on Malawi and the project area

2.1 The country

World-wide, Malawi is one of the least developed countries, with all the implications like high infant mortality rate, low GDP, high illiteracy etc.. It is highly de- pendent on agriculture, and tobacco earns more than 50% of its foreign currency income. Natural resources are scarce and there is no easy access to the sea.

Malawi is situated in southeast Africa, bordering Zambia to the West, Mozam- bique to the Southeast and Tanzania to the North. Administratively it is divided into three regions, Northern, Central and Southern, and sub-divided into 27 districts. Planned decentralisation will strengthen the districts. There are only three urban centres in Malawi, namely Blantyre in the South, the capital Lilongwe in the Centre and Mzuzu in the North.

Fig. 2.1: Malawi and neighbouring countries (ENCARTA WORLDATLAS, 2001) Malawi gained independence from Britain in 1964. After 30 years of one-party-

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BACKGROUND INFORMATION ON MALAWI AND THE PROJECT AREA 11 rule with a life president, people voted in a referendum for a multiparty system.

Since 1994 Malawi has had a democratic government with a president as head of state and government.

Malawi is one of the most densely populated countries in Africa and the doubling of the population over the last twenty years is putting extreme pressure on land and natural resources as well as on the provision of essential social services.

More than half of the population lives below the poverty line. In the 1999 Human Development Report, Malawi is ranked 132^nd out of 143 countries on the Gender- related Development Index while on the Gender Empowerment Index it ranked 90^th out of 102 countries (UNAIDS/MALAWI 1999).

Tab. 2.1: Indicators for Malawi

Surface Area 118,484km²(UNAIDS/WHO 2001)

Total population (1999) 10,640,000 (UNAIDS/WHO 2001) Urban population (1998) 14% (UNAIDS 1999)

Annual population growth rate (1998) 1.9% (UNAIDS 1999) Per capita GNP (US$) (1999) 210 (UNAIDS/WHO 2001) Total adult literacy rate (1995) 56% (UNAIDS/WHO 2001) Total male literacy rate (1995) 72% (UNAIDS/WHO 2001) Total female literacy rate (1995) 42% (UNAIDS/WHO 2001) Infant mortality rate

(per 1000 live births) (2000)

103.80 (N^ATIONAL STATISTICAL O^FFICE / ORCMACRO 2001)

Maternal mortality rate (per 100,000 live births) (2000)

1120 (NATIONAL STATISTICAL OFFICE /ORC M^ACRO2001)

Life expectancy at birth (1996) in years 39 (UNAIDS/WHO2001)

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2.1.1 The HIV/AIDS epidemic in Malawi

The first 17 cases of AIDS in Malawi were reported in 1985. The HIV/AIDS Sur- veillance Report 1998 states 52,853 reported AIDS cases and an estimated HIV prevalence of 16.2% for adults (15-49 years old) (UNAIDS, 1999). As in most developing countries, there is gross under-ascertainment of AIDS cases. This is due to poor reporting systems, insufficient access to health care facilities, unwill- ingness of health workers to diagnose AIDS and not reporting diagnosed cases.

“It is estimated that the reported cases can be more than 6 to 10 fold lower than AIDS cases that actually occurred. The requirement of a positive HIV antibody test result before an AIDS case can be reported, adds to the general problems of under-ascertainment of AIDS in Malawi.” (UNAIDS, 1999:2)

The following figures illustrate the magnitude of the problem in Malawi (all UNAIDS / WHO, 2001:3).

Tab. 2.2: Estimated number of adults and children living with HIV/AIDS, end of 1999

Adults and children 800,000

Adults (15-49) 760,000

Women (15-49) 420,000

Children (0-14) 40,000

Tab. 2.3: Estimated number of deaths due to AIDS during 1999

Deaths in 1999 70,000

Tab. 2.4 Estimated number of orphans Cumulative orphans (since the beginning of the epidemic)

390,000

Current living orphans (at the end of 1999) 275,539

Sentinel surveillance results and estimates for the year 2001

Sentinel surveillance systems for HIV are designed to provide information on

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BACKGROUND INFORMATION ON MALAWI AND THE PROJECT AREA 13 trends to both policy makers and programme planners. The data is useful to help

understand the magnitude of the HIV/AIDS problem in certain geographic areas and among special populations and also for monitoring the impact of interventions. This data also can be used for the preparation of estimates on the national HIV prevalence, suitable for advocacy purposes and district planning.

The HIV sentinel surveillance system in Malawi is implemented by the National AIDS Control Programme (NACP). Data is analysed for syphilis and HIV infection among ANC clients. HIV surveillance has been conducted at Queen Elizabeth Central Hospital in Blantyre since 1985. In 1994 a system of 19 sentinel sites was established. Sites were selected representing the urban, semi-urban and rural areas as well as the northern, central, and southern regions (NACP, 2001:1).

The HIV prevalence estimations derived from sentinel surveillance data pub- lished by the NACP for the year 2001 are presented in Tab. 2.5.

Tab. 2.5: HIV prevalence estimates (NACP, 2001:13)

Indicator Value National adult (15-49) prevalence 15%

Number of infected adults (15-49) 739,000

Urban adult prevalence 25%

Number of infected urban adults 224,000

Rural adult prevalence 13%

Number of infected rural adults 516,000 Number of infected children 65,000 Number infected over age 50 41,000 Total HIV positive population 845,000

Even if prevalence estimates based on this data tend to underestimate prevalence in some age and sex groups, whilst in other groups it is overestimated, these differences compensate for each other. In general, prevalence among

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pregnant women is a good estimate of prevalence amongst adults in the 15 to 49 years age group.

Comparison of the data from previous years with the estimate for the year 2001 could lead to the assumption that HIV prevalence has started to decline. The NACP expert group on HIV/AIDS projection comments:

“Prevalence could decline for several reasons including a high death rate among older adults and behaviour change among young adults. An early indicator of behaviour change is prevalence in the youngest age groups. As noted earlier, prevalence is declining among 15-19 and 20-24 year olds in Lilongwe. However, there is no similar decline in Blantyre. There is no special decline in the youngest age groups. Examination of similar trends for specific sites reveals no clear trend in declining prevalence in the younger age groups except for Lilongwe. Thus, there is some evidence of behaviour change in Lilongwe but not elsewhere. This result needs to be confirmed by examining other evidence of behaviour change (increase in condom use, reduction in the number of partners, later age at first sexual activity) before firm conclusions can be drawn.” (NACP, 2001:17-18)

The government’s response

A deeply ingrained culture of silence concerning HIV/AIDS prevailed in Malawi for many years. AIDS was called a “government disease”, meaning that it did not really exist, and was seen as an ailment only affecting the better-off in urban areas. Before the advent of democracy it was nearly impossible to talk about HIV/AIDS. During these times and up to the mid-Nineties, any effort made by the Government to deal with the problem appeared half-hearted and lacking in real determination.

This started to change with the formation of a cabinet committee on HIV/AIDS, headed by the Vice President of the Republic of Malawi. By the end of the Mil- lennium, the publication of the Malawi National HIV/AIDS Strategic Framework 2000-2004 with a foreword by Dr. Bakili Muluzi, President of the Republic of Ma- lawi, marked the way ahead to a greater commitment of the Government to address the problems related to HIV/AIDS.

The paper focuses on 13 main topics related to HIV/AIDS and serves as a guideline for all activities in the HIV/AIDS field.

Main chapter headings in the National HIV/AIDS Strategic Framework 2000-2004

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BACKGROUND INFORMATION ON MALAWI AND THE PROJECT AREA 15 (MOHP,1999) are:

• Culture and HIV/AIDS

• Youth, social change, and HIV/AIDS

• Socio-economic status and HIV/AIDS

• Despair and hopelessness

• HIV/AIDS management

• HIV/AIDS and orphans, widows, and widowers

• Prevention and HIV transmission

• HIV/AIDS information, education, and communication

• Voluntary counselling and testing (VCT)

• Institutional framework

• Financing and resource mobilisation strategies

• Research

• Monitoring and evaluation

At present the centre of attention is on a Behaviour Change Intervention Strategy (MOHP, 2001) and on the formation of a National Aids Committee (NAC).

HIV transmission mechanisms in sub-Saharan Africa

There are a number of ways for HIV to be transmitted from one person to another. In sub-Saharan Africa and hence in Malawi there are three main transmission mechanisms:

Heterosexual contact is the main source of new HIV infections. Even if a single act of intercourse only carries a small risk of infection, two factors increase the chances of transmission. One is the presence of a sexually transmitted disease (STD) that can act as a door opener for the virus, the other is having unprotected sexual intercourse with various sexual partners.

Mother-to-child transmission accounts for approximately 10% of new HIV infec- tions in southern Africa. The babies get infected during pregnancy, at birth, or via breast-feeding.

Blood transfusion is responsible for a small percentage of new HIV infections.

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Major modes of HIV transmission in sub-Saharan Africa

88

10

2 0

10 20 30 40 50 60 70 80 90 100

%

Heterosexual contact

Mother-to-child transmission Blood transfusion

Fig. 2.2: Major modes of HIV transmission in sub-Saharan Africa

Incubation period and its role for future projections on the pandemic

The average time between a HIV infection and the development of the disease AIDS is approximately eight years (for adults). This distinguishes HIV from most of the other known infectious diseases. As the infected person often does not know about her or his infection status, this will contribute to the spread of the infection.

For children infected at birth, the incubation period is much shorter and most of them will die within the first five years of their life. Infants’ immune systems have not yet fully developed which is the cause for the short incubation period for babies.

The long incubation period plus the absence of symptoms in HIV infected individuals, put policy-makers to an extraordinary challenge. Even if intervention strategies would work immediately and reduce the amount of new infections sub- stantially, the already infected people will fall sick after some years and the prevalence of AIDS will still increase.

For Malawi, this means that, notwithstanding any success in prevention strategies, the annual AIDS death rate will increase during the coming years. This is also reflected in the projections of the policy unit of the National AIDS Control Programme (NACP).

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BACKGROUND INFORMATION ON MALAWI AND THE PROJECT AREA 17

Tab. 2.6: Key HIV/AIDS indicators from the Spectrum projection, 1982-2012 (NACP, 2001:17)

New AIDS cases (in thousands)

1982 1987 1992 1997 2002 2007 2012

Total 0.00 0.66 14.65 54.90 82.70 92.24 103.07

Males 0.00 0.41 7.69 25.78 37.03 41.90 47.24 Females 0.00 0.25 6.96 29.13 45.68 50.34 55.83 Annual HIV positive births (in thousands)

Total 0.00 1.23 9.44 17.33 19.69 20.96 22.52

Percent 0.00 0.33 2.41 4.02 4.21 4.20 4.30 Annual AIDS deaths (in thousands)

Total 0.00 0.45 12.04 50.58 81.05 91.34 101.82

Males 0.00 0.28 6.38 23.94 36.33 41.42 46.65

Females 0.00 0.17 5.66 26.64 44.72 49.92 55.18

Per thousand 0.00 0.06 1.37 5.05 7.21 7.29 7.33

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Cumulative AIDS deaths (in millions)

Total 0.00 0.00 0.03 0.20 0.55 0.99 1.48

Males 0.00 0.00 0.02 0.10 0.26 0.46 0.68

Females 0.00 0.00 0.01 0.10 0.29 0.53 0.80

Whiteside and Sunter summarise this fact as follows:

“…while prevention efforts may aim to lower the number of new infections, the reality is that – without effective and affordable treatment – AIDS will still be increasing long after the HIV tide has been turned.” (WHITESIDE & SUNTER, 2000:28).

The impact of the disease on rural communities

About 85% of Malawi’s population live in rural areas and earn their living from subsistence farming. As in other African countries, women perform more than 80 percent of agriculture and household labour. “They engage in productive work (farming, community constructions) as well as reproductive work (child bearing, caring of the children, the husband, and the sick, household chores, etc). Unfor- tunately they get the least economic benefits from their efforts, especially in terms of farm land and household property, to enable them achieve productive life in the event of the death of the husband.” (BOTHA & MALINDI & MPHEPO, 2001:2)

Lack of arable land and the shortage of money for farm inputs, puts the rural Ma- lawian population under severe pressure.

“Due to the high pressure on land, some 2.6 million smallholder farmers cultivate less than a hectare of land of which half cultivate less than half a hectare. Due to the low level of farm technology, inadequate irrigation, and a shortage of cash and credit to buy hybrid maize seed and inorganic fertiliser, those with between one-half and one hectare can produce only 40-70 percent of their staple food requirement, and by June (only a few months after harvesting) many rural people are reduced to eating two meals per day.” (MOAI,2000:2)

Customs and cultural practices play an important role in the Malawian society.

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BACKGROUND INFORMATION ON MALAWI AND THE PROJECT AREA 19 The HIV/AIDS epidemic has a huge effect on those practices and vice versa.

Certain cultural practices promote the spread of HIV as will be shown later in this chapter.

“The rural communities in Malawi are characterised by customs and organisational arrangements that give each member of the society security. The time spent on funerals, visiting the sick, attending celebrations and ceremonies etc., is in a way a subscription to the society, and thus enables the family to claim social security benefits in times of hardships. (…) These are social structures that have evolved over a long time and are the best known ‘pillars’ of guaranteeing a living to all members of the society. However, with the HIV/AIDS epidemic the very pillars of social security are now threatening not only the integrity of the social structures, but also the existence of its members.” (BOTHA & MALINDI & MPHEPO, 2001:7)

”Kumanda kale kumawirira. Lero njira ya ku manda ndi mseu, ndipo ana saopa maliro.” (In the past graveyards were bushy. Now, the paths to the grave- yards have turned into highways [implying intensive use]. Children are no longer afraid of seeing dead bodies.) Focus Group Discussion with female farmers, Lilongwe. (BOTHA &MALINDI &MPHEPO 2001:8)

The effects of HIV/AIDS on village level and also the applied coping strategies are manifold. The following summary shows the effects HIV/AIDS has on village level in Malawi.

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Effects of HIV/AIDS on village level:

Household labour quality and quantity may be reduced due to:

• HIV infected farmer falling sick

• Having to care for a sick family member

• Having to attend funerals (often lasting for several days) Household expenditure increases due to:

• Having to provide a special diet for sick family members

• Need for special medication

• Funeral costs

Change in demographic structure of villages:

• More orphan-headed households

• More female-headed households

• More single parent-headed households

• More older people involved in farming activities

• More children involved in farming activities

• Less children attending school due to greater involvement in domestic and farming activities

General:

• Loss of knowledge, experience, and skills

• Reduction in cash income

• Reduction in food purchased

• Decline of nutritional status

• Switching to less labour intensive crops (e.g. from tobacco to maize) with implications on foreign currency income for the whole country

• Change in livestock types, e.g. from cattle to goats or chickens

• Less money for inputs

• Less time to care for children

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BACKGROUND INFORMATION ON MALAWI AND THE PROJECT AREA 21 The relationship between HIV/AIDS and poverty

It is not the intention of this paragraph to get involved in a controversy about the question whether HIV/AIDS is a disease of poverty or not.

In Malawi, there is a clear indication of a close relationship between the infection, the outbreak of the disease, and the socio-economic status, which is clearly stated in the National HIV/AIDS Strategic Framework for the years 2000-2004:

“Recent research shows a close relationship between socio-economic issues and the spread of HIV/AIDS. Women continue to turn to prostitution for lack of alternative economic activities while, at the same time, men tend to use money to buy sex. (…) For rural people, poverty and illiteracy reduce their capacity to access and utilise available information and services. This situation increases their risk of HIV infection.” (MOHP, 1999:27)

Examples where poverty aggravates the risk for contracting HIV or exacerbates the situation of infected people are:

• Poor medical infrastructure

• Poor access to STD treatment

• Lack of information due to poor education

• No money to buy condoms

• Desperation leading people to sell sex in order to earn money

Some aspects of cultural practices

This paragraph gives a brief introduction to some of the cultural practices existing in Malawi that might contribute to the spread of HIV/AIDS.

“Malawi has a very rich culture.” (MALEWEZI,2001:15) Culture is passed on to the children through education. In some tribes, initiation ceremonies are part of the traditional education system. One of the main types of initiation ceremonies is designed to prepare girls and boys for marriage. Marriage is an important institu- tion in the Malawian society as marriage marks the end of adolescence. The process of raising children includes their preparation for future roles as husbands and wives. In traditional education, men teach boys and women teach girls. Tra- ditional educators are trained to talk open about sex and sexuality in a frank and

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open manner (MALEWEZI, 2001:17).

Among the Chewa and Yao people, initiation ceremonies for girls involve a ritual known as fisi or kuchotsa pfumbi. This is supposed to prepare the girls physically for marriage / the marital act. “A man (usually much older than the girl) is asked to have sex with the girl in order to ‘open the womb’ or to break the mandatory communal period of sexual abstinence.” (MALEWEZI, 2001:16) This is one of the most common cultural practices that spread HIV/AIDS.

There are two different kinds of fisi known and practised in the research area (see Annex III, Villager interview: Question No.20). One is kuchotsa pfumbi, the initiation rite. The other type of fisi is when a newly married woman does not get pregnant within a two or three months period after marriage. Another man is then invited to the house to impregnate the woman within a month’s period (BOTA &

MPHEPO &MALINDI, 2001:10;FOREMAN &SCALWAY, 2000:19;MALEWEZI, 2001:16;

PERSONAL OBSERVATION). To show the difference, in this study the two types known as fisi are divided into kuchotsa pfumbi and fisi.

Poverty is the main reason for girls to get married at an early age. Parents are not able to support their daughters. They expect the sons-in-law to take over this responsibility. Another reason is that some parents fear the girls will become pregnant out of wedlock and therefore take them out of school so that they can marry, thus bringing honour to the family (MALEWEZI, 2001:14).

Chokolo is the Chichewa word for widow inheritance. A brother of the late husband of the widow is asked to inherit the widow and children to ensure the social welfare of the family (MALEWEZI, 2001:18; BOTA & MALINDI & MPHEPO, 2001:11).

Although this cultural practice can be understood as a social security system, it bears a high risk of HIV/AIDS transmission from the widow to the brother if the deceased husband has died of AIDS. In many villages Chokolo was stopped some time back, but it was still mentioned by the villagers as the most important cultural practice, beside fisi and kuchotsa pfumbi, leading to transmission of HIV/AIDS (see Annex III, Villager interview: Question No.20).

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2.2 The project area

The project area consists of the three Extension Planning Areas (EPA, see also chapter 3.1) Chileka, Ming’ongo, and Mpingu (from West to East). They are all situated within the Lilongwe West Regional Development Projects (RDP), along the main road from Lilongwe to Zambia about 33° east and 14° south. The area covers approximately 87,000 hectare (ha) with about 200,000 people living in 735 villages. The area receives nearly 800 mm precipitation during the rainy sea- son lasting from November to April.

About 85% of the total area is classified as arable land. Most of the cultivated land is used by small-scale or subsistence farmers for maize, ground nut, tobacco and sweet potato production. Agriculture is the major source of income, supplemented by a considerable number of men who work in Lilongwe.

Most of the infrastructure is located along the main road to Zambia, while the population living in areas some distance away from the main road often does not have access to basic services.

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Tab. 2.7: Facts about Chileka EPA, Ming'ongo EPA, and Mpingu EPA (Source:

ADD-Report; RDP Lilongwe West, Crop Estimates 2001)

EPA Chileka EPA Ming’ongo EPA Mpingu

Total area (in ha) 19,116.25 41,562.50 26,406.25

Arable land (in ha) 16,601.25 35,362.50 22,406.25

Non-arable land (in ha) 2,515.00 6,200.00 3,800.00

Maize (in ha) 10,426 7,138 6,198

Ground nuts (in ha) 1,848 1,400 714

Burley tobacco (in ha) 438 1,341 254

NDDF tobacco (in ha) 152 206 44

Sweet potatoes (in ha) 419 368 904

Sections 8 16 12

Blocks 64 128 96

Number of villages 135 378 222

Number of farm families 12,341 20,098 16,019

Number of female headed households

3,826 4,915 approx. 5,300

Number of health centres 1 4 3

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3 The role of the MoAI in HIV/AIDS prevention and miti- gation

This chapter touches firstly on the organisational structure of the Ministry of Agri- culture and Irrigation (MoAI), and goes on to highlight the initial forays into HIV/AIDS related issues at ministry level. Further on in the chapter specific focus is put on the May 2001 Training of Trainers (ToT) Workshop and preliminary at- tempts made to implement an MoAI Workplace Programme.

3.1 The organisational hierarchy of the Ministry

As stated in chapter 2, Malawi is a predominantly agrarian society. As such, it is not surprising that Malawi’s MoAI is present throughout most strata of the country. It employs people in diverse disciplines: from accountants and economists to research scientists and cartographers, and from field-level extension workers to headquarters administrators. The MoAI is divided into eight departments:

• Administration (which is comprised of the Divisions of Human Resources, Finance, Internal Audit, Procurement, and Transport)

• Agriculture Extension Services

• Agriculture Research and Technical Services

• Animal Health and Industry (Veterinary Services)

• Crops

• Irrigation

• Land Resource Management / Conservation

• Planning

Geographically, the MoAI is divided into eight Agricultural Development Divisions (ADD) which oversee 31 Regional Development Programs (RDP) which super- vise 171 Extension Planning Areas (EPA). These EPAs are divided into sections of varying number. An EPA is an organisational unit, with operation sections each consisting of several villages. All eight MoAI departments have representative units at ADD level.

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THE ROLE OF THE MOAI IN HIV/AIDS PREVENTION AND MITIGATION 27

ADD RDP EPA Section

Organisational structure of the MoAI

Fig. 3.1: Organisational structure of the Ministry of Agriculture and Irrigation (MoAI)

Fig. 3.2: Organisational structure of the Lilongwe Agriculture Development Divi- sion / Rural AIDS Pilot Area

8 Sections

Lilongwe ADD

5 RDPs including Lilongwe West RDP (LWRDP)

12 EPAs in Lilongwe West RDP including the three pilot EPAs of

16 Sections 12 Sections

Organisational structure of the Lilongwe ADD / Rural AIDS Pilot Area

Chileka

Ming'ongo Mpingu

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3.2 Activities of the MoAI on HIV/AIDS

As it became clear that the HIV/AIDS epidemic was having a negative impact on every aspect of the agricultural sector, the MoAI undertook multi-faceted measures to understand and mitigate its debilitating effects. In late 1999, the NACP, UNAIDS, and the World Bank jointly provided assistance to the MoAI in a preliminary study into HIV/AIDS in Malawi’s agricultural sector. This study led to:

• The initial concept and design of the MoAI Workplace Programme (see 3.2.2)

• The preliminary Rural AIDS Community Initiative, which will be addressed later

• A six-month consultancy to design a rural response to HIV/AIDS, which eventually contributed to the framework of the MoAI’s Strategic Plan as well as the Community Toolkit. This was designed to help mainstream HIV/AIDS messages within ongoing rural development programmes in the MoAI.

• The formation of an organisational and operational structure to develop and implement local response to HIV/AIDS within the agricultural sector.

• The commitment, at various management levels within the MoAI, to begin implementation of both the Rural AIDS Community Initiative and the Workplace Programme (MOAI, 2000:3).

In addition to these initiatives, the DAES was tasked to develop a HIV/AIDS policy which can be implemented systematically by the MoAI, both internally (with employees) and externally (with clients).

The reasons for this were that internally, the MoAI was:

• Facing escalating attrition rates resulting from illness and deaths of employees. According to a survey of 285 staff of the MoAI in Lilongwe, 76%

reported losing at least one colleague to AIDS (MALINDI, 2000).

• Experiencing a braindrain of many of the best-trained and most experienced employees through illness and death. Knowledge and skills were being lost at an alarming rate, and it remains difficult, if not impossible, to replace this loss timewise.

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THE ROLE OF THE MOAI IN HIV/AIDS PREVENTION AND MITIGATION 29

• Being hit by the mounting demands on its budget due to the increasing absenteeism, sick leave, and funerals of its staff. There was simply not enough money to sustain the transport needs and subsequent absence of productive staff to attend the ever-increasing funerals (often paid by the MoAI) of deceased MoAI staff and their families.

• Witnessing a decreasing standard in the delivery of services to its client, the rural farmer.

Externally, the MoAI was:

• Observing the same attrition rates among rural farmers and their families as it was seeing with its own employees.

• Seeing scarce resources, such as money and labour, diverted from the agricultural sector to the care of the sick and their eventual funerals.

• Tracking the plummeting yields of both revenue-generating and subsistence food crops due to the strain on the small farm holder. As farmers or their spouses became too sick to work, other less skilled and knowledge- able people were forced to take on the responsibility of planting and main- taining crops. As these family members were often ill-equipped, production and quality dropped.

Therefore, in March 2001, the DAES formed a team of MoAI staff that would be commissioned to revise the initial policy draft submitted in late 2000. In late May 2001, selected members of the DAES change team worked on the revision. The focus was to address the MoAI’s internal concerns regarding the stifling effects of the HIV/AIDS epidemic on its employees and their families, to recognise the MoAI’s clients’ needs and to address how the MoAI could better mitigate the impact of the epidemic in their communities.

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The Rural AIDS Toolkit was designed to supplement the Rural AIDS Community Initiative and facilitate the mainstreaming of HIV/AIDS messages into field level extension workers’ existing work and to act as a guideline for facilitation and documentation of their proposed HIV/AIDS work. It emphasises a participatory approach that relies on communities taking responsibility for the prevention and mitigation of HIV/AIDS and the devastating effects that result. This toolkit became the basis for the ToT Workshop (see 3.2.1). Many of the tools, techniques, and exercises in the toolkit were discussed and practiced in the ToT Workshop.

Another key feature of the toolkit is that it is gender-based. It has been proposed that the Rural AIDS Community Toolkit’s mainstreaming and implementation would be overseen by the MoAI’s recently-formed Gender and AIDS Desk Offi- cers. This was an effort to ensure equitable roles and responsibilities in the target areas, and to make certain there is an equal distribution of resources, knowledge, and resulting benefits between men and women. As of October 2001, this toolkit is still in a discussion and refinement stage.

3.2.1 The Training of Trainers Workshop in May 2001

Realising the profound need to address HIV/AIDS issues within the agricultural sector, the DAES developed a curriculum for a multi-faceted workshop for cross- sectoral field level staff. It took place in early May 2001 and included extension staff from the MoAI and Ministry of Health and Population (MoHP) along with teachers, selected farmers, and other community leaders working and living in the three pilot EPAs of Chileka, Ming’ongo, and Mpingu in the Lilongwe West RDP.

The workshop’s objectives were to both build the capacity of the participants to facilitate positive change in the areas of HIV/AIDS prevention as well as sharing the tools and skills necessary for mitigating the debilitating effects of HIV/AIDS in the communities in which they live and work (BOTA, 2001:1).

Ultimately, it is hoped, the lessons learned in the RAIDS Initiative pilot area as well as refinements to the ToT curriculum will be incorporated into a scaling-up of these mainstreaming methods to other ADDs (see 5.1).

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THE ROLE OF THE MOAI IN HIV/AIDS PREVENTION AND MITIGATION 31 3.2.2 The Workplace Programme

Another key component of the MoAI’s activities to mitigate the burden of the epidemic on the agricultural sector was the development and implementation of a ministry-wide HIV/AIDS Workplace Programme. This programme targets all employees of the MoAI and wants to give them comprehensive information about the HIV/AIDS problem. The goal was to use MoAI Headquarters, De- partmental Head Offices, and the Lilongwe ADD Head Office as initial entry points for this initiative. Particular attention was given to the design and applica- tion of HIV/AIDS mainstreaming tools and techniques within existing programmes and projects. Also, emphasis was placed on improving strategies for the scaling- up of the Workplace Programme to the other ADDs, research stations, and the like.

Task forces were formed at headquarter, ADD, and RDP level to ascertain and address the ever-changing needs and demands placed on these offices and their employees by the HIV/AIDS epidemic.

Training and orientation sessions were planned to explain the philosophy, ration- ale, and goals of the Workplace Programme, and also to highlight the importance of a holistic bottom-up and top-down saturation of HIV/AIDS messages throughout the MoAI.

As dialogue increased, new workplace initiatives were undertaken. Two drama groups were formed consisting of MoAI staff in Lilongwe as a way of disseminat- ing HIV/AIDS messages in a different manner. Another drama group was formed by field staff in the Mpingu EPA. Their goal was to integrate theatre performances on HIV/AIDS into structured village events, where it would be used as an icebreaker to promote interest and dialogue among the villagers. More recently, a Drama Taskforce has been formed within the Lilongwe divisions of the MoAI to investigate and employ theatre as a means to disseminate HIV/AIDS messages within the context of existing agricultural programmes and projects (see 6.5.1).

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4 Materials and methods

This chapter gives a comprehensive summary of the materials and methods used for gathering information, analysis, and findings of the research. As the study is focused on two main subjects, this chapter has been divided into 4.1 and 4.2.

The first part of the chapter is dedicated to the evaluation of the Training of Trainers (ToT) Workshop held in May 2001. Evaluation methods include interviews, questionnaires, and participant observation of village events which were conducted by participants of the ToT Workshop. This was done to ascertain the participants’ knowledge on HIV/AIDS and to scrutinise whether the methods taught and used during the ToT Workshop were adequate and applied by the participants.

Concerning the second part of the study, the theatre topic, the main research activities were to meet existing drama groups working on HIV/AIDS issues in the project area. Performances were observed, discussions with the drama groups and interviews with spectators were conducted. Possible perspectives and recommendations for the further integration of theatre into the activities of the DAES were developed as a result of the study.

4.1 Materials and methods for training evaluation

Being aware of the short time span between the ToT Workshop conducted in May 2001 and this evaluation, the DAES was more interested in assessing the activities following the training than in evaluating the impact of the activities on the rural population. The evaluation was therefore designed to lead to recommendations for the next proposed ToT Workshop in the pilot area Lilongwe West RDP.

The major research questions for the evaluation of the Training of Trainers Workshop in May 2001 were:

• What did the participants learn during the workshop?

• How did the ToT Workshop affect the ToT participants?

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MATERIALS AND METHODS 33

• How do the ToT participants organise and conduct village events?

• What are the effects on the villagers?

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The evaluation of the ToT Workshop was mainly focused on interviews with ToT participants and villagers, supplemented by participant observation of village events on HIV/AIDS issues (see 5.2). For each of the eight village events a data sheet was compiled containing information, e.g. who conducted the event, how many villagers attended, what the covered topics were, which methods had been used etc.. The original plan was to observe ten village events but due to funerals and other ongoing activities in the communities, only eight events could be observed. At least one team member took detailed notes of each event assisted by a simultaneous translator.

To evaluate the knowledge of the training participants a questionnaire had been developed based on a study conducted at the beginning of the year 2001 (BOTHA

& MALINDI & MPHEPO, 2001) and 29 ToT participants were interviewed. The age of the 29 interviewed ToT participants varies between 22 and 63 years. 22 of them are male, seven are female. 15 of the interviewees are employed by the MoAI, eight by the MoHP, three by the MoE, two are farmers and one is a chief.

The questionnaire included seven knowledge questions on HIV/AIDS. Those questions, used in the above mentioned study (BOTHA & MALINDI & MPHEPO, 2001:48-57), were asked again to compare the knowledge of untrained and trained (by the MoAI) field extension staff. It was primarily designed to assess the knowledge of the ToT participants. To amplify what had been written they were also questioned about their experiences in conducting village events. These interviews contained 20 questions and were conducted in English without a translator. The questionnaire as well as the semi-structured interview is attached to this report in Annex II.

In order to get an impression of how the villagers perceived the village events and if the village events had any effect on their attitudes and opinions, 35 villagers were interviewed: 18 men and 17 women. According to the gender of the in- terviewee, the interview was conducted by a female / male team member and translator. The semi-structured guideline interview, containing 27 questions, was divided into three parts. The first part was dealing with questions on the village event itself, the second focused more on knowledge, and the third was concerning personal opinions.

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Fig. 4.1: Interview with one of the female villagers after the village event in Thumbi on 5 September 2001

For the purpose of rating and comparing that information and to find out whether there were any differences in knowledge and personal opinions, 36 villagers (18 men and 18 women) from other communities who never attended an HIV/AIDS related village event were asked the same knowledge and personal opinion questions (21 questions).

The interviewees were selected according to three different age groups: youth (up to 20 years), young age group (21 to 39 years), old age group (40 and above), and chiefs.

All tables concerning the evaluation materials of the ToT Workshop are also attached in Annex II.

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4.2 Materials and methods for the theatre research

For the purpose of exploring the possibilities of integrating theatre into the DAES activities the research team observed ten different theatre events (some of them comprising several performances), interviewed 18 spectators and met twelve drama groups. All of the drama groups were from Lilongwe or the pilot area except St. Anne's Drama Group from Nkhotakota, which was considered to be an example of a hospital-based group, based in a different part of the country. Be- sides data collection at grass-root level during and after theatre performances, interviews were conducted with theatre specialists and practitioners from Chan- cellor College in Zomba and the Blantyre-based NGO The Story Workshop as well as from government institutions.

For each of the observed performances data sheets were completed, giving an overview of the number of actors performing, the covered topics, the structure of the whole event, the storylines, the interaction with the audience and the general impression of the observers (see 6.3). All performances were simultaneously translated for at least one person taking notes. These data sheets provided the basis for the reconstruction of the storylines. They were also used to recall the setting and the number of spectators and to identify and critically reflect especially interesting points (for an example of the data sheets see Annex IV).

All groups were usually interviewed after their performances. Most of these group interviews were conducted in the form of group discussions, facilitated by one or two team members assisted by one translator. In two cases the director of the group was interviewed.

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The questions asked in the group interviews can be divided into three different parts – the guideline for the interviews can be seen in Annex II:

• Questions on the organisational form of the group: how often they re- hearse and perform, how they create storylines, about their personal backgrounds, etc.

• Questions on their opinion about theatre as a means for HIV/AIDS prevention

• Questions on their perspectives and on the constraints and needs of the groups

Fig. 4.2: Group interview with Chitedze HIV/AIDS Awareness Group

Spectators were interviewed individually directly after the end of a performance in semi-structured interviews by one team member supported by a translator. In total, nine men and nine women were interviewed. Although this number is clearly not representative for the whole audience, the answers do give an impression of how theatre is being perceived by spectators of the observed performances.

HIV/AIDS Prevention in the Agricultural Sector in Malawi

Landwirtschaftlich-Gärtnerische Fakultät

Schriftenreihe des Seminars für Ländliche Entwicklung